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CONSULATE GENERAL OF INDIA

BIRGUNJ (NEPAL) Recent photo

(Size 3.5 cm

X
APPLICATION FOR REGISTRATION OF INDIAN NATIONALS 3.5cm)

1. Name: (Shri /Smt/ Master/ Ms) :


(in capital letters) _____________________________

2. Fathers / Husbands Name : Shri _____________________________

3. Date of Birth : _____________________________

4. Educational Qualification : _____________________________

5. Profession (please tick) : Student / Business / Service_______

6. Permanent address in India: (a) House/ Ward No___________________


(b) Mohalla / Vill _________________ Police Station ______________ (c)
Post Office _________________ District ____________________
(d) State ____________PIN _________ Phone _________________
7. (a) Name of School/ College/ Employer/ Shop in Nepal:

___________________________________________________________

Address: ___________________________________________________________________

__________________________ Phone________________________________

(b) Residential address in Nepal: ________________________________

____________________________________________________________________________

_____________________________ Phone ______________________________


8. Date / year of arrival in Nepal : _____________________________
9. Details of Documents (a): _____________________________
(Passport / Election Card/
Domicile or Caste Certificate/ (b): ______________________________________
Any other paper):
(c): ______________________________________

(d): ______________________________________
Place :
Date :

(Signature of the Applicant)

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